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Abstract: A 4-year-old girl had a recurrent rash with pruritus since birth, which was more pronounced in winter and recurrent even after treatment. Combining the patient’s medical history and clinical symptoms, the examination led to the diagnosis of atopic dermatitis. This may be related to the patient’s history of allergies or may be caused by weather changes. After systematic treatment, the patient’s rash symptoms were relieved and her condition was stabilized.
[Basic information] Female, 4 years old
Disease Type】Atopic dermatitis
Hospital】Xiang Ya Second Hospital of Central South University
Date of consultation】December 2021
Treatment Plan】Topical medication (hydrocortisone butyrate cream, tacrolimus ointment, glyburide lotion) + oral medication (loratadine tablets)
Treatment Period】After 1 week of outpatient treatment, regular review
Effectiveness】After treatment, the patient’s itchy skin disappeared and the rash symptoms were reduced.
I. Initial interview
When we first saw the patient, the patient’s skin was dry and rough all over the body, including the face, and there were erythematous skin patches on the side of the upper limbs with scaling symptoms. The family told us that since birth, the patient had often had recurrent eczema and dry skin with pruritic symptoms, which were relieved by medication but still recurred. The patient’s father was asked about the presence of allergic rhinitis and did not have small animals at home. The diagnosis of atopic dermatitis could be made by performing hematological examination and allergen test.
II. Treatment history
The results of the patient’s hematological examination indicated the presence of high serum IgE levels and eosinophilia, and the results of the allergen test indicated a high sensitivity to milk, a mild sensitivity to shrimp, and a moderate sensitivity to eggs. After the diagnosis was confirmed, I informed the patient’s family that medication was available, and the family agreed, so the patient was prescribed loratadine tablets for anti-allergy treatment, hydrocortisone butyrate cream for topical application to help relieve the symptoms of erythema and scaling of the skin, as well as glyburide lotion to relieve the itching symptoms, and tacrolimus ointment to promote the recovery of the lesions. It is also important to pay attention to the cleaning of the patient’s skin in daily life, and to apply moisturizing creams with simple ingredients and moisturizing effects, as well as to abstain from eating foods that can easily cause allergies.
Third, the effect of treatment
After medication and daily care, the patient’s dry skin and skin lesion symptoms have significantly improved. On the third day of treatment, the patient’s skin erythema and scaling symptoms were reduced and the itching symptoms were relieved. On the 7th day of treatment, the patient’s itching symptoms disappeared, the erythematous skin symptoms were significantly relieved, and the dryness symptoms were significantly reduced. In addition, with the daily care work, the dry skin symptoms had completely disappeared when the patient was re-examined, and the skin was smooth and delicate at this time, indicating that the treatment effect was more satisfactory.
IV. Notes
Seeing that the patient’s symptoms improved after treatment and the skin recovered smooth and delicate, I felt happy for the patient from the bottom of my heart, in addition, the family also needs to pay attention to the following points in daily life.
1, in daily life, family members should pay attention to the protection of the patient’s skin, pay attention to the use of warm water to clean the skin, avoid the stimulation of cold and hot water on the skin, while avoiding the use of irritating body wash.
2, in terms of diet need to try to avoid allowing patients to eat milk, shrimp, eggs and other foods that avoid easily lead to patient allergies.
3, family members should also pay attention to trimming the patient’s nails to avoid repeated scratching due to itching, which can easily lead to secondary infection, and also arrange to pay attention to warmth, especially in winter when the air is dry and cold, which can easily stimulate the aggravation of skin lesions.
V. Personal insight
Atopic dermatitis is a relatively easy to relapse disease, usually related to genetics, seasonal changes and other factors, but the disease is relatively easy to treat, after drug treatment combined with daily care, the symptoms can be significantly improved. Like the 4-year-old girl in this case, her father has allergic rhinitis, so it cannot be ruled out that her atopic dermatitis is genetically related, but after active systemic treatment, the skin damage improves significantly. It is also important to keep warm and avoid allergic foods in daily life to avoid recurrence of the condition as much as possible.